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NSW: A new direction for Mental Health
NSW: A new direction for Mental Health
NSW DEPARTMENT OF HEALTH
Locked Mail Bag 961
North Sydney NSW 2060
Tel. (02) 9391 9000
www.health.nsw.gov.au
Published by © NSW Department of Health 2006.
This work is copyright. It may be reproduced in whole or in part
for study training purposes subject to the inclusion of an acknowledgement
of the source. It may not be reproduced for commercial usage or sale.
Reproduction for purposes other than those indicated above,
requires written permission from the NSW Department of Health.
SHPN (CMH) 060086
ISBN 0 7347 3952 4
Further copies of this document can be downloaded from the
NSW Health website: www.health.nsw.gov.au
June 2006
NSW HEALTH A New Direction for Mental Health i
Premier’s foreword
The day I became Premier I pledged my Government would do more – much more – to help those who livewith mental illness.
The NSW Government has already significantly boosted funding and released the Interagency Action Plan forBetter Mental Health – a whole of government approach to providing clinical and support services to improvecare for people with mental illnesses.
However our efforts to improve the system can not stop with our own State public services. This is why I took the issue to the Council of Australian Governments. NSW is working to secure a National Action Plan on Mental Health that will strengthen Commonwealth, State and non-government services and ensure they form part of a more connected care system.
New South Wales: A New Direction for Mental Health is a plan to transform and uplift the State's mental health services.
We're also backing this plan with a revolution in the way mental health services are delivered.
We will provide more community care and early intervention so that problems are identified and managed earlier instead of escalating into acute episodes that require hospitalisation.
People with a mental illness deserve continuity of care and a more seamless delivery of services, and that iswhat we are committed to provide.
We will therefore build stronger links between the public, private and community sectors, between hospitalsand GPs, and between the State and Federal Governments.
We will also invest in attracting and retaining our mental health workforce.
Our investment over the next five years will deliver more services, earlier, and provide better support for families.
Above all, our plan is a statement to those who live with a mental illness – and to their families and carers –that we have heard your voices, we have responded to the call for change.
I warmly commend New South Wales: A New Direction for Mental Health and sincerely thank all who madeit possible. Together we are bringing new hope and better days in place of the neglect and decline of the past.
The Honourable Morris IemmaPremier of NSW
Liverpool Mental Health Unit opened February 2006
NSW HEALTH A New Direction for Mental Health iii
Contents
Ministers’ foreword ............................................1
The need for change ..........................................3
A snapshot of mental health servicesinvesting in mental health......................................3
A new direction for mental health services ......5The HASI program ................................................5
Investing in mental health ................................7
The five year plan ..................................................7
Where will the funding be invested?......................7
What we want to achieve ..................................8
Where we will place our effort..........................8
Promotion, prevention and early intervention ........................................9
What will we do? ..................................................9What we will build on ........................................10
Improving and integratingthe care system..................................................11
What will we do? ................................................11
What we will build on ........................................12
Participation in the community and employment, including accommodation ........13
What will we do? ................................................13
What we will build on ........................................14
Workforce development ..................................15
What will we do? ................................................15
What we will build on ........................................16
How will we know if our programs are working? ....................................17
Appendices
Appendix 1Mental Health five-year recurrent funding............19
Appendix 2Mental Health capital works ................................20
Appendix 3COAG Mental Health five-year funding................21
List of figures
Figure 1. Estimated numbers of people with mental illnesses by severity ..............4
Figure 2. Standardised suicide rates, by year of registration, NSW vs. Australia 1991-2004 .................4
NSW HEALTH A New Direction for Mental Health 1
Ministers’ foreword
‘New South Wales: A New Direction for Mental Health’ is a five-year plan to provide earlier and better access to a greater range of services than has ever been provided by public mental health services in NSW.
The NSW Government is committed to supporting more people with a mental illness and their families.
This new plan direction is significant in that for the first time it aims to balance hospital focused care with community care.
Strong community mental health services are critical to delivering effective mental health services for people of all ages, and their families and carers.
‘New South Wales: A New Direction for Mental Health’ also outlines how extensive NSW public mentalhealth services are – we provide treatment for the full range of mental illnesses, from non-acute to emergency situations, as well as for children, adults and older people.
A $939 million program over the next five years will commence with $149 million in additional funding in the 2006/2007 financial year.
The five-year plan includes $338 million of new recurrent funding enhancements for initiatives and expandedservices that will commence in 2006/07, following the $263 million in spending enhancements announced by the Premier as Health Minister.
Having placed mental health on the national agenda at the recent Council of Australian Governments, NSW continues to take the lead in pursuing stronger and better connected services for people with mental illness.
‘New South Wales: A New Direction for Mental Health’ aligns and delivers on the commitments made by all Australian governments earlier this year to significantly increase investment in our mental health services.
John Hatzistergos Cherie BurtonMinister for Health Minister Assisting the Minister for Health
(Mental Health)
Liverpool Mental Health Unit opened February 2006
NSW HEALTH A New Direction for Mental Health 3
The need for change
Mental health problems can affect any of us at anyage. They can have a devastating impact on our lives,as well as those of our families and friends.
The wider community is affected in many ways,and the economic and social cost is great.
Across Australia, the levels of psychiatric distressare rising. Levels of acuity are also rising.
Reasons for this change are yet to be fullyunderstood but may include increasing work and financial demands, changes in social supports, increasing inequality, and changesin drug and alcohol use.
Despite improvements in access to mental health services, there is still an enormous demandfor a wide range of care and support services forpeople with mental illness.
People with a mental illness are still at greater risk of homelessness, of contact with the criminal justice system and still have a below-average life expectancy.
This demand cannot be met without enhancing services, and making better use of the full range of services offered by NSW and CommonwealthGovernments, and the private and non-government sector.
This was the basis for NSW setting the agenda for improvement in mental health at the Council ofAustralian Governments’ meeting in February 2006.
The Commonwealth Government responded with a $1.8 billion funding enhancement over five years, calling on the states to match on a pro-rata basis their funding commitment.
This document details the NSW Government’s plan.
A snapshot of mental healthservices in NSW in 2006
> There were approximately 1.1 million peoplewho experienced a mental illness in NSW in 2005-06.
> About 170,000 or two to three per cent had a severe mental illness.
> Mental health units in NSW hospitals managedapproximately 26,000 overnight admissions in2004-05.
> Community mental health services in NSWmade 2.3 million clinical interventions eachin 2004-05.
> The suicide rate was 8.6 per 100,000 in 2004 –the lowest in 50 years.
> In 2005-06, the dedicated mental healthrecurrent budget was $854 million. Almosthalf the budget is dedicated to communitymental health services.
1991
20
15
10
5
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 20040S
tand
ard
ised
rat
es p
er 1
00,0
00
Australian suicide rate NSW suicide rate
Figure 1. Estimated numbers of people with mental illnesses by severity
2001-02
1,200,000
1,000,000
800,000
600,000
400,000
200,000
2002-03 2003-04 2004-05 2005-060
moderatesevere mild
Source: NSW Health Department Mental Health Clinical Care and Prevention (MH-CCP) model, version 1.11
Figure 2. Standardised suicide rates, by year of registration, NSW vs. Australia 1991-2004
Source: Causes of death, Australia 2003 and 2004, ABS, Catalogue Number 3303.0, ABS Information Paper – Suicides 2001
4 NSW HEALTH A New Direction for Mental Health
NSW HEALTH A New Direction for Mental Health 5
A new direction for mental health services
Local and international research shows thatcommunity based mental health care is not only cost effective, but also as clinically effective as inpatient care. Community mental health care has been shown to result in higher self-reportedquality of life and service satisfaction ratings among service users.
The NSW Government will provide more communitycare and early intervention so that problems areidentified and managed earlier instead of escalatinginto acute episodes that require hospitalisation.
People with a mental illness deserve continuity of care and a more seemless delivery of services. We will therefore build stronger links between thepublic, private and community services, betweenhospitals and GPs, and between the State and Federal Governments.
For example, the Housing Accommodation Support Initiative (HASI), which currently supportsover 700 people, has shown effective community-based mental health services can lead to improvedcircumstances for clients.
HASI is a unique partnership between the NSW Department of Housing, the NSW Departmentof Health and the mental health non-governmentsector.
The NSW Government will develop communitymental health services with a strong earlyintervention and recovery orientation with a view to achieving the best possible clinical, social, functional and general health outcomesfor consumers, their families and carers.
An independent evaluation by the University
of NSW found that for the first 118 entrants
to the HASI program:
> 90 per cent had a reduction in hospitalisation
in the first year
> 85 per cent had successfully maintained
their tenancy
> 72 per cent had made new friends since joining
the program
> 92 per cent of clients were regularly seen
by their case manager
> 89 per cent were still in contact with
their psychiatrists.
One man spent 18 months in hospital
prior to joining HASI and his mental
illness was compounded by a history
of drug and alcohol abuse, and he rarely
left his home. After 12 months on the
program, he said:
“I’m living a life now. I was in so much
emotional pain in the past I didn’t want
to live anywhere. It wasn’t until now that
these people have got me into a lifestyle
which I enjoy. I’m living a life and I enjoy
it. I never had that before.”
The second evaluation report found that almost half of clients reported that substance abuse was no longer an issue for them.
The HASI program
6 NSW HEALTH A New Direction for Mental Health
NSW HEALTH A New Direction for Mental Health 7
Investing in mental health
This plan details the additional investment that will be made to significantly expand the capacityof our services so that the right care can beprovided at the right time.
In 2006/07, the NSW Government will spend
over $1 billion on services for people with
mental illness. These programs span healthservices, the justice system, and housing andsupported accommodation. On top of this, theNSW Government will also resource our policeforce and child protection workers to respond to the crisis situations that can arise when people are affected by acute mental illness.
A $939 million program of additionalexpenditure will be implemented over the nextfive years, commencing with $149 million in the2006/07 financial year. This five-year programcomprises:
> $338 million in new additional recurrent funding commencing in the 2006/07 Budget
> $263 million in additional recurrent fundingpreviously announced
> $338 million in capital works, includingadditional funding for new capital works, works-in-progress, and privately financed projects.
Where will the new funding be invested?
In a significant shift in policy, of the new $338million of additional funding to commence in the2006/07 Budget, $279 million is for communitybased care. This funding will be invested in:
> community rehabilitation services ($41.5 million)
> 24 hour community outreach services to respondto emergencies ($51.4 million)
> new youth mental health services ($28.6 million)
> expanded services for older people with agerelated mental illness ($37.3 million)
> a 24 hour state-wide access line to be staffed by mental health professionals ($26.3 million)
> a traineeship program for additional Aboriginalmental health workers ($6.6 million)
> new dual diagnosis services and betterintegration of drug and alcohol and mental health services ($17.6 million)
> community forensic services ($6.5 million)
> NGO supported accommodation services ($49.7 million)
> support for families and carers ($13.5 million).
The five year plan
This five year plan includes a significant boost to a range of programs acrossgovernment, comprising an additional:
> $102 million for prevention, promotion and early intervention
> $712 million to improve and integrate the care system
> $114 million for enhancing participation of people with mental illness in the community,including more stable accommodation
> $11 million for workforce development programs.
8 NSW HEALTH A New Direction for Mental Health
What we wantto achieve> Reduce the prevalence and severity of
mental illness.
> Reduce the prevalence of risk factors thatcontribute to the onset of mental illness andprevent longer term recovery.
> Increase the proportion of people with anemerging or established mental illness who areable to access the right health care and otherrelevant community services at the right time.
> Increase the focus of services on coordinatedcare in the community and early intervention.
> Increase participation of people with a mentalillness in the community, employment, educationand training.
> Increase the availability and stability ofaccommodation for people with a mental illness.
.
Where we willplace our effortConsistent with the plan which the NSW Government took to the Council ofAustralian Governments in February 2006,the NSW Government aims to achieve change through four areas of effort:
1. Promotion prevention and earlyintervention across the lifespan
Building resilience, raising community awarenessand treating mental illness as early as possible toreduce long-term disability.
2. Improving and integrating the care system
Improving the linkage between inpatient and community health services and their linkages to GPs, community support, supported accommodation, social support services and other key service partners.
3. Participation in the community and employment,including accommodation
Helping people live a quality life with stable housing and opportunities to participate inemployment and education.
4. Better workforce capacity More doctors, nurses and allied health professionals so that services are available when needed.
NSW HEALTH A New Direction for Mental Health 9
Promotion, prevention and early intervention
What will we do?In 2006/2007, the NSW Government willinvest $18.1 million in promotion, preventionand early intervention programs. Over the next five years, we will spend an additional $102.2 million in new funding. These programs comprise:
> $10 million to expand university-based research including: $6 million for the Brain and Mind Research Institute to conductresearch and provide clinical outreach services;and $4 million for the University of NSW to further their research into schizophrenia,depression and anxiety disorders.
> $28.6 million to develop tertiary mental health treatment services for young people 14-24 years of age. These services will focus on intervention at the early stages of theirserious mental illness and effective evidencebased treatment, bringing together specialistyouth mental health treatment services, generalpractitioners, drug and alcohol workers andother relevant services in a one-stop shop.
A pilot program will commence in Gosfordin 2006 and will be progressively implemented in other Area Health Services.
In South West Sydney, a team with drug and alcohol and mental health expertise will visit youth services to provide assistance andsupport in working with young people with co-morbidity issues.
> $37.3 million to expand specialist communitymental health teams to provide assessmentand treatment for older people with mentalillness and age-related mental health problems.
This program will build on 2005/06 budgetenhancements for older peoples mental health community teams and community-based programs and operate in partnership with aged care services, GPs and other key service partners.
> $26.3 million for a 24-hour NSW mental health telephone advice, triage and referral service, staffed by mental health clinicians. This will link into the National Health Call Centre agreed to by the Council of Australian Governments.
The NSW Government recognises the importance of activities to promote better mental health foreveryone, prevent and minimise risk factors and intervene early to improve treatment outcomes.
The NSW Government is working in partnership with stakeholders to increase community awareness and knowledge of ways to promote good mental health and reduce stigma.
We are implementing programs that build resilience in young people, reduce the risk factors associated with drug use, and intervening early with high-risk families.
10 NSW HEALTH A New Direction for Mental Health
What we will build onSince 2003, we have:
> Trained more than 2,000 school and TAFE counsellors, mental health workers and psychologists from the Department of Juvenile Justice and the Department ofCommunity Services under the School-LinkTraining Program focussing on collaborativeapproaches to managing adolescent depressionand related disorders.
> Provided early psychosis services across NSW for young people with early onsetpsychosis. Services include outreach, family support and individual and group interventions.
> Developed a suicide risk assessment and management framework to improve the capacity of all NSW Area Health Servicestaff who play a key role in early detectionand intervention with people who are a risk of suicide. An electronic learning package has been developed and is being rolled out across NSW.
> Conducted Mental Health First Aid Training courses across NSW to increase the community’s knowledge, awareness and confidence about mental illness and toteach appropriate responses to people withmental health problems. For example, the NSW Department of Housing and NSWDepartment of Community Services areproviding courses to their employees.
> Trained more than 1,000 health professionals and 4,000 parents in Positive Parent Trainingthrough the NSW Mental Health ParentingProgram.
> Established the Mental Health Infant Perinatal Care Program, which aims to screen all pregnant women to identify the risk of, or existing mental health problemsincluding depression, and provide services for those families.
> Implemented the Suicide Prevention for OlderPeople Training Manual. This is a guide to assistmental health educators across the state toprevent and detect depression and preventsuicide deaths in older people.
> Piloted My Health Record, a personal health record held by the consumer to assist them and their families and carers to be more informed partners in themanagement of their illness across multiple care providers.
> Established Australia’s first Chair of SchizophreniaResearch together with the NeuroscienceInstitute of Schizophrenia and Allied Disordersand the University of New South Wales.
> Developed a resource kit to support professionals working with the children of parents with a mental illness to address the stigma surrounding mental illness which can affect these young people.
> Provided $3.2 million per annum to expandspecialist community mental health teams toprovide assessment and treatment for olderpeople with mental illness and age-relatedmental health problems.
> Implementation of dual diagnosis earlyintervention programs, targeting young people, Aboriginal men and women at risk of homelessness.
NSW HEALTH A New Direction for Mental Health 11
Improving and integrating the care system
An effective, integrated care system for people with a mental illness provides the right care at the right time, to avoid the escalation of illness and to promote recovery.
This plan aims to improve and integrate the care system by significantly expanding the capacity of our services so that they can meet escalating demand. It also strengthens the connections betweenservices, particularly building better links with the private primary care sector, Commonwealth and non-government service providers.
Implementation of the NSW Interagency Plan for Better Mental Health is already showingresults in this area. New partnerships have emerged between government agencies responsible fordelivering services. Stronger relationships have also formed with the non-government sector, theresearch community, general practitioners and consumers, families and carers.
These partnerships have flourished through new programs, such as Housing Accommodation and Support Initiative, alternative transport arrangements in rural areas to free up police resources, and shared care arrangements with GPs.
Recent funding enhancements are increasing access to services – more beds have opened and morecommunity services provided with additional staff. This plan significantly builds on previous investment.
What will we do?In 2006/2007, the NSW Government willinvest $115.5 million in programs that improveand integrate the mental health care system.Over the next five years, we will spend anadditional $712 million in new funding. These programs include:
> $51.4 million for Community Mental HealthEmergency Care. This will fund an additional 65 specially trained professionals to respond toout of hours emergency and acute communityresponses across the State by 2007/08, anddoubling by 2009/10.
> $6.5 million to enhance community forensicmental health services to provide assessment,court diversion, discharge planning from custodyand case management of difficult adults andadolescents with a mental illness in contact withthe criminal justice system.
> $17.6 million to better integrate mental health services with drug and alcohol servicesand trialling new interventions. This includes
specialist support for offenders and youngpeople, and the trial of methamphetaminetreatments.
In 2006/07, 20 new graduates will be placed with drug and alcohol and mental health services to strengthen the workforce and build relationships across the two areas.Funding will support new positions that providespecialist drug and alcohol advice and assistanceto mental health services and emergencydepartments.
> Establish Integrated Primary and Community Care Services together with General Practitionersto provide integrated, multi-disciplinary services.Some of the initial IPCCSs will focus on mentalhealth and drug and alcohol services. GeneralPractitioners in these services will work closelywith local community, drug and alcohol and mental health services.
12 NSW HEALTH A New Direction for Mental Health
> $5 million to assist people with mental illnessin correctional centres who are exhibitingchallenging behaviours.
> $151.7 million to increase the number of acute and non-acute beds. An additional300 mental health beds have been planned andwill be opened over the next three years.
> $172 million to build and operate a new forensic facility at Long Bay Prison.
> $14.3 million to expand community basedprofessional mental health services including child and adolescent services.
> $10.8 million to reconfigure seven 16-bedunits across NSW to operate as short-medium stay specialist assessment and treatment facilitiesfor older people with severely and persistentlychallenging behaviours associated with dementia and/or mental illness.
> $117 million for building new facilitiesto accommodate new mental health bedsincluding works at Lismore, Illawarra andBloomfield Hospital
> $23 million to St Vincent’s Hospital toredevelop and integrate mental health serviceswith drug and alcohol services.
> $117.4 million to refurbish and relocate facilities at Concord, Gosford, Newcastle and Orange.
> $5.8 million to establish PsychiatricEmergency Care Centres at Major MetropolitanHospitals such as Blacktown, Liverpool, Nepean,Campbelltown, Wollongong, Hornsby, Wyong,St. George and St Vincent’s.
What we will build on> We have opened 283 beds since 2001.
> Developed a rural critical care model, whichincludes 24/7 telephone triage for mental healthemergencies and transport by health staff.
> A Unique Patient Identifier process has beencreated and will be implemented in each AreaHealth Service to enable Area clinicians to accesslinked treatment and outcome databases fortheir patients.
> Since 2002 an estimated 3,920 people havebeen diverted away from the criminal justicesystem into community care with theestablishment of court diversion services in 22local courts throughout NSW.
> A 40 bed mental health-screening unit openedthis year at the Metropolitan Remand Centre at Silverwater.
> Establishment of a community forensic mentalhealth service for people in contact with thecriminal justice system.
> Conducted 77 education and training workshopsfor 1,627 GPs about mental health issues andestablished local networks between communityGPs and the public mental health services for themanagement of patients with a mental healthproblem. These workshops are being expandedto include a drug and alcohol component.
> $23 million in additional funding for community mental health services including the establishment of the Area RehabilitationProgram, providing individual rehabilitation and support programs which includes betterintegration across the care system.
> $6 million over four years for the developmentof older people’s mental health services and servicepartnerships across NSW.
> Two pilot partnerships services with residential aged care providers for people with severely and persistently challenging behavioursassociated with dementia and/or mental illness.
NSW HEALTH A New Direction for Mental Health 13
What will we do?In 2006/2007, the NSW Government willinvest $12.7 million in programs that increaseparticipation of people with a mental illness inthe community, employment and education.Over the next five years, we will spend anadditional $113.8 million in new funding. Some of the programs include:
> $58.8 million boost for the HousingAccommodation and Support Initiative, in partnership with the Department of Housing and NGO sector. This will provide an additional 234 support packages to the 736 already funded.
A significant proportion of this funding will be for individualised support packages for peoplerequiring ongoing monitoring after inpatient care.In partnership with the NGO sector, this will helppeople re-settle in the community and preventre-admission. In 2006/07, 100 of these supportpackages will be available. The Department ofHousing will spend $5 million of these funds onthe leasing of properties to accommodate peopleparticipating in the Housing Accommodation andSupport Initiative.
> $41.5 million for community rehabilitationservices. This includes:
– extra clinical rehabilitation specialists that willprovide assessments and options for people at the earliest stages of their disorder. Thisincludes individualised plans for intervention,transition to community care and specialistpsychosocial rehabilitation in the community.
– the introduction of Vocational EducationTraining and Employment (VETE) clinicians to provide individual assessments andintervention; preparation and support of VETE plans; linkages and advice on mental health issues for the client as required to Vocational Rehabilitationproviders (CRS), employment services andEducational providers; and development oflocal service networks to facilitate referral and management options.
– the introduction of Recovery and ResourceServices to increase the capacity of NGOs toprovide quality social and leisure opportunitiesfor people with a mental illness, based on best practices.
Participation in the community andemployment, including accommodationRehabilitation and support services promote recovery across all settings – inpatient to community –to enable patients to live their life to the fullest potential, avoiding unnecessary relapse and reducingthe need for hospitalisation.
These assist patients to achieve independence, self esteem, housing stability, social and family connections, education and employment and a meaningful life in the community.
A major priority of the NSW Government is to enhance rehabilitation and support services for people with mental illness to participate in the community, education and employment.
This includes enabling people with mental illness to have stable housing by linking them with other personal support services. We will improve referral pathways and enhance links betweenclinical, accommodation, personal and vocational support programmes and expanding support for families and carers.
14 NSW HEALTH A New Direction for Mental Health
> $12.2 million for an Aboriginal mental health workforce program that will place localAboriginal mental health trainees in mainstreamcommunity mental health teams to address thehigh and complex needs of Aboriginal people,and for Aboriginal people to better engage with mental health services.
This program is being expanded following a pilot in the Greater Western Area HealthService, which won the Premier’s Public Service Award in 2005.
> An additional $13 million for NGOs to enhance the NSW Family and Carer MentalHealth Program to work in a collaborativeapproach with Area Health Services across the state, to provide:
– specialist clinical advice and a comprehensiverange of support services for families and carers
– education and training for families and carers
– information for new carers about their rights and responsibilities
– involvement of families and carers inassessment, care planning and dischargeplanning of a loved one
– better access and referrals for families andcarers to other community support services.
By suitably supporting carers and providing
them with information we can achieve:
> a reduction in psychotic symptoms.
> increased management of and adherence to medication regimes.
> improved resilience and coping skills in families and carers.
> increased understanding of the mental illness affecting a loved one.
What we will build onSince 2003, we have
> Delivered 736 supported accommodation placesthrough the HASI program.
> Established the NSW Family and Carers MentalHealth Program to fund non-governmentorganisations and mental health services toprovide education and support for families andcarers. This $3.6 million statewide program is thefirst of its kind in Australia. It is an evidence-based program to guide support for, andpartnerships with, families and carers of peoplewith mental illnesses and disorders across NSW.
> Developed clinical networks with GPs and other service providers, including monitoring of referral pathways and establishment of a clinical contact point between mental health services and other care providers.
> Trialled the Vocational Education Training andEmployment program. This program aims to:
– provide services in preparation of VETE plan
– provide advice to vocation rehabilitationproviders (CRS), employment services andeducation providers
– develop local service networks to facilitategreater referral and management options.
NSW HEALTH A New Direction for Mental Health 15
Workforce development
A highly skilled, stable and well-supported workforce is crucial for leading the reforms necessary to enhance the quality, effectiveness and responsiveness of services.
Shortages exist across Australia and across all mental health professional groups, including mental health nurses and psychiatrists.
Workforce capacityA package on this scale requires a significant boost to the State's mental health workforce – as well as a major enhancement of training and development programs for existing staff.
Workforce recruitmentThe $338 million package in new community health initiatives – which forms the centrepiece of theGovernment's package will require significant recruitment of new staff.
The Government will therefore recruit 425 new clinicians over five years, including more than 300 nurses (60 of whom will be Nurse Practitioners).
To help achieve the target of 300 nurses, we will provide 100 scholarships to upgrade Enrolled Nurses to Registered Nurses specialising in mental health.
The 425 new clinicians will be allocated
to the following community programs:
Proposed projects 2006/07 2010/11
Aboriginal Mental Health Workforce Program 10 20
Community Mental Health Emergency Care 52 109
Youth Mental Health Model 13 63
Co-morbidity Package 25 25
Community Forensic Mental Health Services 8 8
Specialist Mental Health Services for Older People 36 95
Mental Health CommunityRehabilitation Program 30 90
Older People's Transitional Behavioural Assessment andIntervention Services Unit 15 15
Total 189 425
What are we going to do?In 2006/2007, the NSW Government willinvest $2.2 million in programs that increasethe number of people working in mentalhealth. Over the next five years, we will spend an additional $11 million in new funding. The programs comprise:
> Recurrent funding to train extra doctorsin psychiatry.
> Expanding uptake of General Practitioners in theGP procedural training Program in Mental Health.
> New graduate and transition training programsfor nurses and allied health staff that choose to work in mental health.
> Provision of 600 undergraduate and postgraduatescholarships for mental health nurses.
16 NSW HEALTH A New Direction for Mental Health
> Scholarships for five mental health nurses tosupport development of new models of care.
> Mental Health Reconnect programs for nursingand allied heath. Already 52 nurses have taken upjobs in mental health as a result of this program
> Guaranteed employment for up to 50 NSWpsychologists while undertaking the ClinicalMasters course.
> Development of locum networks to support rural mental health professionals to accessprofessional leave.
> Research on attraction factors to mental health careers.
> School traineeships targeting careers in mental health.
> Development of distance education qualificationin mental health for enrolled nurses.
The NSW Government will continue working
with the Commonwealth in:
> maximising uptake of undergraduate registered nursing university places that major in mental health
> encouraging psychologists to take up clinical psychology post graduate places
> expanding capacity for post graduateopportunities for all professions in the mental health sphere
> maximising opportunities for Commonwealthand state supported overseas trained specialistand registrar programs.
> advocating for further increases in medical,nursing and clinical psychology training placesin Universities to meet community needs.
What we will build on
> Creation of brand new training networks for trainee psychiatrists starting in 2006. This initiative has already meant that 14 moredoctors have now chosen psychiatry as theirspeciality on top the 204 already in training.
> In all networks there is priority filling of ruralpositions with significant investment in local and state Network Directors of Training.
> Rural scholarships are also available for doctors that choose to do more than one rotation in a rural area.
> Government funded graduate certificate mentalhealth nursing courses for up to 25 students.
> A GP procedural training program that has seen 12 GPs upskill in mental health.
> The Teams of Two project is specifically workingto improve the skills of general practitioners indealing with Mental Health and substance abuseproblems. This project is being rolled out in all 38 Divisions of General Practice with 80 training events planned for 2006/07.
NSW HEALTH A New Direction for Mental Health 17
We will need to be satisfied that improvement isoccurring within NSW against the followingmeasures:
> the prevalence of mental illness in the community
> the rate of suicide in the community
> rates of use of illicit drugs that contribute to mental illness in young people
> percentage of people with a mental illnesswho receive mental health care
> mental health outcomes of people who receivetreatment from NSW public mental health services
> the rates of community follow up for people within the first seven days of dischargefrom hospital
> re-admission to hospital within 28 days of discharge
> participation rates by people with mental illness ofworking age in employment
> participation rates of people with mental illnessin education and training
> prevalence of mental illness among people who areremanded or newly sentenced to adult and juvenilecorrectional facilities
> prevalence of mental illness among homeless populations.
How will we know if our programs are working?
A range of processes have been identified that will provide an indication of the extent to which ourinitiatives are working.
NSW HEALTH A New Direction for Mental Health 19
2006-07 2007-08 2008-09 2009-10 2010-11 5 yrs
Enhancement of services with additional funding commencing in the 2006-07 BudgetExpanding university-based mental health research* 10.0 – – – – 10.0
Specialist youth mental health services 1.4 6.8 6.8 6.8 6.8 28.6
Specialist mental health services for older people 4.0 5.6 7.7 10.0 10.0 37.3
State-wide 24 hour mental health access by telephone 2.7 5.3 5.3 6.5 6.5 26.3
24-hour community mental health emergency care 6.8 6.8 10.7 13.6 13.6 51.4
Specialist assessment and treatment services for older people 2.2 2.2 2.2 2.2 2.2 10.8
Community forensic mental health services 1.3 1.3 1.3 1.3 1.3 6.5
Integration of mental health and drug and alcohol services 5.6 3.0 3.0 3.0 3.0 17.6
Capital grant for St Vincent's hospital
to improve mental health services* 23.0 – – – – 23.0
Mental Health Community Rehabilitation Program 3.8 5.3 8.4 12.0 12.0 41.5
Family and Carers Mental Health Program 1.5 3.0 3.0 3.0 3.0 13.5
Aboriginal Mental Health Workforce program 0.8 0.8 1.6 1.6 1.6 6.6
Expansion of the Housing Accommodation
and Support Initiative Stage 4 5.5 11.0 11.0 11.0 11.0 49.7
Increasing mental health acute beds 3.0 3.0 3.0 3.0 3.0 15.0
Sub-total 71.5 54.0 64.0 74.0 74.0 337.7
Enhancement of services with additional funding announced in previous BudgetsIncreasing mental health acute and non-acute beds 14.5 30.5 30.5 30.5 30.5 136.7
Operating new forensic hospital at Long Bay prison 1.0 3.0 22.0 24.0 24.0 74.0
Building community-based professional services
including child and adolescent services 1.5 3.2 3.2 3.2 3.2 14.3
Improving mental health clinical
information and accountability 1.5 1.5 1.5 1.5 1.5 7.6
Workforce development 2.2 2.2 2.2 2.2 2.2 11.0
Aboriginal Mental Health services 0.7 1.2 1.2 1.2 1.2 5.7
Expansion of the Housing Accommodation
and Support Initiative Stage 3 1.8 1.8 1.8 1.8 1.8 9.1
Corrective Services programs for inmates
with mental illness and intellectual disability 1.0 1.0 1.0 1.0 1.0 5.0
Sub-total 24.2 44.5 63.5 65.5 65.5 263.3
Total recurrent 95.7 98.6 127.6 139.6 139.6 600.9
* These grants were provided in May 2006 for service enhancements to be delivered in 2006-07
Appendix 1Mental Health five-year recurrent funding
2006-07 2007-08 2008-09 2009-10 2010-11 5 yrs
New capital works and increase in scope
Relocation of Mandala Mental Health Unit at Gosford Hospital 0.8 2.1 9.9 – – 12.9
Bloomfield Forensic & Tertiary Mental Health Units 1.1 – 12.6 14.4 6.3 34.3
SES/Illawarra AHS Child & Adolescent Unit – Stage 3 0.5 5.5 2.3 – – 8.3
Non Acute Mental Health Unit at Sutherland Hospital 2.1 3.3 1.1 – – 6.5
Relocation of Rozelle Mental Health Facility (increase in scope) 5.3 15.9 1.4 – – 22.6
Sub-total 9.8 26.9 27.2 14.4 6.3 84.6
Works-in-progress
Lismore – Adult, and Child & Adolescent mental health units 14.2 12.1 3.0 – – 29.3
Illawarra Older Persons Mental Health Unit 2.1 2.0 – – – 4.1
Non Acute Mental Health Unit at Coffs Harbour Hospital 1.9 3.2 2.3 – – 7.3
Non Acute Mental Health Unit at Newcastle
(James Fletcher Hospital) 1.9 1.7 4.7 – – 8.2
Non Acute Mental Health Unit at St George 1.3 3.4 3.6 – – 8.3
Non Acute Mental Health Unit at Shellharbour 1.3 1.9 4.2 – – 7.4
Mental Health Stage 3A projects 3.2 – – – – 3.2
Orange Hospital Redevelopment
– Mental Health Component 0.4 0.4 7.0 12.0 4.1 23.9
Forensic Hospital at Long Bay
(related capital works by the Department of Health) 0.9 1.2 0.1 – – 2.2
Relocation of Rozelle Mental Health Facility* 11.2 11.1 0.9 – – 23.2
Psychiatric Emergency Care Centre at Blacktown Hospital 1.1 0.3 – – – 1.3
Psychiatric Emergency Care Centre at Liverpool Hospital 1.1 0.3 – – – 1.3
Psychiatric Emergency Care Centre at Nepean Hospital 1.1 0.3 – – – 1.3
Psychiatric Emergency Care Centre at Campbelltown Hospital1.3 0.3 ≠– – – – 1.6
Psychiatric Emergency Care Centre at St Vincent's Hospital 0.4 – – – – 0.4
Sub-total 43.3 37.9 25.8 12.0 4.1 123.0
Privately financed projects (value of Public Sector Comparator)
Forensic Hospital at Long Bay – – 66.9 – – 66.9
Newcastle Mater Hospital - mental health component – 15.8 19.0 – – 34.8
Prison Hospital - mental health component – – 28.5 – – 28.5
Sub-total – 15.8 114.5 – – 130.3
Total capital program 53.1 80.6 167.4 26.5 10.3 337.9
* This excludes $22.6m in increased scope to complete the transfer of tertiary beds from Rozelle
20 NSW HEALTH A New Direction for Mental Health
Appendix 2Mental Health capital works
NSW HEALTH A New Direction for Mental Health 21
2006-07 2007-08 2008-09 2009-10 2010-11 5 yrs
Promotion, prevention and early intervention
Expanding university-based mental health research* 10.0 10.0
Specialist youth mental health services 1.4 6.8 6.8 6.8 6.8 28.6
Specialist mental health services for older people 4.0 5.6 7.7 10.0 10.0 37.3
State-wide 24 hour mental health access by telephone 2.7 5.3 5.3 6.5 6.5 26.3
Sub-total 18.1 17.7 19.8 23.3 23.3 102.2
Improving and Integrating the care system
Increasing mental health acute and non-acute beds 17.5 33.5 33.5 33.5 33.5 151.7
Operating new forensic hospital at Long Bay prison 1.0 3.0 22.0 24.0 24.0 74.0
Building community-based professional service including
child and adolescent services 1.5 3.2 3.2 3.2 3.2 14.3
Specialist assessment and treatment services for older people 2.2 2.2 2.2 2.2 2.2 10.8
Improving mental health clinical information and accountability 1.5 1.5 1.5 1.5 1.5 7.6
24-hour community mental heath emergency care 6.8 6.8 10.7 13.6 13.6 51.4
Aboriginal Mental Health Workforce program 1.5 2.1 2.9 2.9 2.9 12.2
Community forensic mental health services 1.3 1.3 1.3 1.3 1.3 6.5
Integrating mental health and drug and alcohol services 5.6 3.0 3.0 3.0 3.0 17.6
Capital grant for St Vincent's hospital to improve mental health services* 23.0 23.0
Corrective Services programs for inmates
with mental illness or intellectual disability 1.0 1.0 1.0 1.0 1.0 5.0
Building new forensic and prison hospitals at Long Bay 0.9 1.2 95.5 - - 97.6
Building mental health facilities to accommodate
new mental health beds 29.7 33.1 33.6 14.4 6.3 117.0
Construction of mental health facilities to better integrate
services at Gosford, Concord, Newcastle and Orange Hospitals 17.7 45.3 38.3 12.0 4.1 117.4
Building and expanding Psychiatric Emergency Care Units 4.8 1.0 – – – 5.8
Sub-total 115.9 138.2 248.7 112.7 96.5 711.9
Participation in the community and
employment, including accommodation
Expansion of the Housing Accommodation and Support Initiative (HASI) 7.3 12.9 12.9 12.9 12.9 58.8
Mental Health Community Rehabilitation Program 3.8 5.3 8.4 12.0 12.0 41.5
Family and Carers Mental Health Program 1.5 3.0 3.0 3.0 3.0 13.5
Sub-total 12.7 21.1 24.3 27.9 27.9 113.8
Increasing workforce capacity
Workforce development 2.2 2.2 2.2 2.2 2.2 11.0
Sub-total 2.2 2.2 2.2 2.2 2.2 11.0
Total 148.8 179.2 295.0 166.0 149.9 938.9
* These grants were provided in May 2006 for service enhancements to be delivered in 2006-07
Appendix 3COAG Mental Health five-year plan
SHPN (CMH) 060086
